WORKFORCE AND HEALTH SYSTEM PERFORMANCE (WAHSP)

There is broad recognition that achieving universal health care requires a greater focus on health human resources in relation to health system performance and outcomes for children. Pediatricians have an important role and responsibility to contribute to the education of future generations of pediatricians and other health professionals, to new knowledge development, and to advance policies, and practices within national health care systems and globally.

Pediatric training and pediatric professional development programs are designed to ensure high levels of competence for child health providers. High levels of clinical competence help ensure optimal clinical outcomes for children. However, in many regions of the world the child health workforce is stretched, access to higher-levels of support is not readily available, and there are limited numbers of child health experts and little capacity for pediatricians to contribute to higher-order tasks such as curriculum and training development, child health advocacy and policy development, and health system strengthening includingtraining and support of other health cadres.  Yet these are the settings in which the world’s children suffer the most. 

Work-force distribution around child health is highly skewed. In general, countries with the worst child health outcomes have the lowest number of trained child health professionals and the lowest rates of spending on education and training for their health workforce. There is good evidence that a well-trained workforce is necessary in order to implement and sustain health interventions.

Workforce related to child health is a key priority of the WHO and the UN. The overall goal in the WHO Global Strategy Workforce 2030 is to ‘improve health, social and economic development outcomes by ensuring universal availability, accessibility, acceptability, coverage and quality of the health workforce through adequate investments to strengthen health systems, and the implementation of effective policies at national, regional and global level.’ Some of the suggested 2020 global milestones in this report include:

• All countries have inclusive institutional mechanisms in place to coordinate an intersectoral health workforce agenda. 
• All countries have established accreditation mechanisms for health training institutions. 
• All countries are making progress on health workforce registries to track health workforce stock, education, distribution, flows, demand, capacity, and remuneration.
• All bilateral and multilateral agencies are strengthening health workforce assessment and information exchange.

Furthermore, this report states: ‘Health systems can only function with health workers; improving health service coverage and realizing the right to the enjoyment of the highest attainable standard of health is dependent on their availability, accessibility, acceptability, and quality. Mere availability of health workers is not sufficient: only when they are equitably distributed and accessible by the population, when they possess the required competency, and are motivated and empowered to deliver quality care that is appropriate and acceptable to the sociocultural expectations of the population, and when they are adequately supported by the health system, can theoretical coverage translate into effective service coverage’.  Thus, workforce needs both numbers and quality—competence, motivation, and empowerment. 

The United Nations has adopted new Sustainable Development Goals (SDGs) for 2016–2030. The SDG’s follow the Millennium Development Goals of 2000–2015, with a call to action to people and leaders across the world to ensure a life of dignity for all. The health workforce underpins the proposed health goal, with a target (3c) to substantially increase health financing, and the recruitment, development and training and retention of the health workforce in developing countries, especially in least developed countries and small island developing States.  At the global level there is then a clear mandate to better support the health workforce through the framework of the SDG’s.

The organization and function of health care delivery systems are an increasing focus of the global community. Concurrently there is recognition of a disconnect between professional training programs and how they prepare graduates to work within and influence operation of the health care system.  The influential Lancet Commissions report on Health Professionals for the 21st Century, identified the need for greater strategic planning and interaction between education of the health workforce and the health care delivery systems if there is to be effective impact on health outcomes.  

In 2017, IPALA sponsored a workshop in London, England to focus on child health workforce and ow to link workforce data to country level education and service needs and strengthen strategic planning and advocacy around health system performance. The workshop identified the clear need to a better understanding of the pediatric workforce globally and hence better tailor training and pediatric support in regions of greatest need. 

Currently we lack data on our workforce, where the gaps are, where the training support needs are, what the critical needs are, and how this can interface with the health care delivery systems. WHO in their workforce planning have identified data needs and that at a regional level there is need to collect reliable workforce and health outcome metrics. To be of assistance to child health providers, a system of data collection that enables better understanding of training gaps and training needs would enable better targeting of support.

In a 2018 IPA survey of member societies there was overwhelming positive response for increased global support for training and workforce development.  This interest mirrors the results of the London workshop held in 2016 in London.  The needs are enormous as illustrated in a first ever global scoping of existing pediatric training programs across 121 countries that was conducted by Drs. Christiana Russ, Beth Harper and colleagues and supported by the IPA – showing wide disparities in pediatric resources, education programs, and models of service delivery (Russ, et al.).

In 2019, IPALA had an exploratory meeting with the Institute for Health Metrics and Evaluation (IHME) in Seattle to assess areas of potential collaboration given IHME interest in issues of access to pediatric care and the relationship to the global health burden for children.  IHME has been working with a partner to map health care facilities. They are also using several sources of data to identify health work force at the local and eventually at the facility level. The meeting generated good discussion on common areas of interest, but progress was stalled by the COVID-19 pandemic.  

1.  Establish a workforce and health system performance (WaHSP) working group that links to existing global expertise able to advance knowledge and support strategic national issues related to child health workforce and health systems performance.

2.  Establish an advocacy presence in global discussions and initiatives related to child health workforce and health systems performance.

3.  Develop competency-based training modules on workforce and health system performance that can be incorporated into pediatric residency programs and continuing professional development programs.

4.  Support the development of pediatric expertise in national workforce and health system performance through establishment of a pediatric fellowship program (WaHSP Fellows).

There is tremendous opportunity for such a structure to have impact.  We will maximize networking across academic institutions to identify existing initiatives that may be aligned and/or better supported to achieve scale, thus engaging existing initiatives and maximizing their potential for impact.  While the intent is to mobilize global resources, the focus is on national strategies for improving child health and well-being and all initiatives will be developed through the priorities and opportunities defined by national academic pediatric structure and pediatric professional societies.  This is schematically illustrated in the following diagram.  

1. Global strategy on human resources for health: workforce 2030. 16059 Global Strategy Workforce 2030, WHO. https://www.who.int/health-topics/health-workforce#tab=tab_2
2. Julio Frenk J, Chen L, Bhutta Z et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet 2010; 376: 9756; p1923-1958
3. Skochelak SE, Lomis KD, Andrews JS, Hammoud MM, Mejicano GC, Byerley J.  Realizing the vision of the lancet Comission on Education of Health Professionals for the 21st Century: Transforming medical education through the Accelerating Change in Medical Education Consortium.  Medical Teacher 43(2):51-56 2021.
4. WHO Fifth Global Forum on Human Resources for Health – Key areas for action and the way forward. https://cdn.who.int/media/docs/default-source/health-workforce/5gf/fifth-global-forum-on-hrh-outcomes-two-pager.pdf?sfvrsn=df83f500_3&download=true

1. Harper BD, Nganga W, Armstrong R, Forsyth KD, Ham HP, Keenan WJ, Russ CM. Where are the paediatricians? An international survey to understand the global paediatric workforce. BMJ Paediatr Open. 2019 Jan 31;3(1):bmjpo-2018-000397. doi: 10.1136/bmjpo-2018-000397
2. Harper BD, Nganga W, Armstrong R, et al. Global Gaps in Training Opportunities for Pediatricians and Pediatric Subspecialists. Acad Pediatr. 2020 Aug;20(6):823-832. doi: 10.1016/j.acap.2019.12.002.